Keep Masks in Heathcare: a letter to Oregon hospital administrators

 

I write regarding the responses from the OHA to KATU's report on a recent protest against the lifting of the state mask mandate in healthcare settings.(1) The OHA statements are inadequate and non-responsive.

 

Mask mandates work well to reduce the quantity of airborne viral particles, in part because the presence of a mandate signals the serious need for protections (2, 3).  Although case numbers are undercounted because of lack of access, accuracy, and reporting of testing, wastewater levels remain persistently high in Multnomah County and hospitalization rates remain persistently high in Oregon (4, 5).

 

Graph of Multnomah County Wastewater from Biobot, levels March 15, 2023: 607copies/mL  (higher than any time before 21/22 surge, persistently high since summer 22). Graph of Oregon hospitalizations for COVID-19 from OHA Public Tableau, as of March 15 2023 (persistently high: since May 2022 has not gone below 200)

Further vaccination is currently unavailable; I and many Oregonians received a bivalent booster over six months ago, and are considered "up to date," although vaccine efficacy appears to wane in less than three months (6, 7).  Most COVID deaths at this point are among those who are vaccinated (8).  Those who are immunocompromised may not receive the same benefit from vaccination (9).  Moreover, because of the unchecked spread and evolution of the virus, vaccination cannot keep up with evolving variants (10). To slow the continued evolution of the virus to ever-more immune-evasive variants, we must slow the spread of infection.  

 

In addition, death and longcovid are not the only negative individual outcomes from infection.  Current evidence suggests infected adults and children are at greater risk of new onset diabetes (11, 12, 13), adults are at increased risk of cardiac problems (14, 15) and the long-term impact on children’s cardio-vascular health is uncertain (16). In addition, people can experience kidney injury (17, 18), liver damage (19), erectile dysfunction (20, 21), hearing loss (22-25), immune dysfunction (26-29), brain and memory dysfunction (30), ocular damage (31, 32) and dermatological complications (33, 34). In fact there are few organs that SARS-CoV-2 can’t harm, largely because COVID-19 is a vascular disease (35-37) with immune-mediated severity impacting multiple organs (38, 39). SARS-CoV-2 is an airborne virus that is transmitted via the respiratory system (40), but the disease it causes is not localized to the respiratory tract (41) with its multi-organ, multi-system impacts stemming from its vascular nature, the associated immune perturbation, and other systemic effects. 

 

The observable increase in community illness and chronic ill health (42, 43) should motivate those responsible for public health to take all possible measures to insure our well-being.  That is not what lifting the mask mandate in healthcare conveys. 

 

Perhaps, if the dangers to public health will not motivate state leaders, those responsible for health care systems will consider not only their ostensible goal of doing no harm, but also their legal liabilities (44).

 

For all these reasons and more, I urge you to maintain mask mandates in the healthcare settings for which you are responsible. 

 

Thank you.

 

 

 

 

(1) Group in Portland protests lifting of mask mandate in medical settings https://katu.com/news/local/group-in-portland-protests-lifting-of-mask-mandate-in-medical-settings

(2) Lifting Universal Masking in Schools — Covid-19 Incidence among Students and Staff  https://www.nejm.org/doi/full/10.1056/NEJMoa2211029

(3) Death Panel Podcast: Why Mask Mandates Work w/ Ellie Murray  https://soundcloud.com/deathpanel/why-mask-mandates-work-w-ellie-murray-030923

(4) Biobot Covid-19 Wastewater Monitoring in the U.S. https://biobot.io/data/

(5)  OHA Public Tableau: Oregon's Hospitalization Trends by Severity https://public.tableau.com/app/profile/oregon.health.authority.covid.19/viz/OregonCOVID-19HospitalCapacity/HospitalizationbySeverity

(6) Waning Immunity Against XBB.1.5 Following Bivalent mRNA Boosters https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9900747/

(7) Bivalent booster effectiveness against severe COVID-19: Outcomes in Finland, September 2022 – January 2023 https://www.medrxiv.org/content/10.1101/2023.03.02.23286561v1.full.pdf

(8) Why Do Vaccinated People Represent Most COVID-19 Deaths Right Now?  https://www.kff.org/policy-watch/why-do-vaccinated-people-represent-most-covid-19-deaths-right-now/

(9) mRNA COVID Vaccine Effectiveness Lower in Immunocompromised People https://www.technologynetworks.com/vaccines/news/mrna-covid-vaccine-effectiveness-lower-in-immunocompromised-people-367003

(10) Bivalent COVID Boosters Offer No Extra Protection, Studies Suggest https://www.usnews.com/news/health-news/articles/2023-01-11/bivalent-covid-boosters-offer-no-extra-protection-studies-suggest

(11) Diabetes risk rises after COVID, massive study finds https://www.nature.com/articles/d41586-022-00912-y

(12) Diabetes after SARS-CoV-2 infection https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00324-2/fulltext

(13) Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged <18 Years https://www.cdc.gov/mmwr/volumes/71/wr/mm7102e2.htm

(14) Long-term cardiovascular outcomes of COVID-19 https://www.nature.com/articles/s41591-022-01689-3

(15) The impact of COVID-19 and COVID vaccination on cardiovascular outcomes https://academic.oup.com/eurheartjsupp/article/25/Supplement_A/A42/7036729

(16) SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association https://www.ahajournals.org/doi/full/10.1161/CIR.0000000000001064

(17) Pathophysiology of COVID-19-associated acute kidney injury https://www.nature.com/articles/s41581-021-00452-0

(18) Covid-19: Infection increases the risk of kidney disease even in mild cases https://www.bmj.com/content/374/bmj.n2189

(19) Impact of COVID-19 on liver https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462210/

(20) Tip of the iceberg: erectile dysfunction and COVID-19 https://www.nature.com/articles/s41443-022-00540-0

(21) COVID-19 Infection Is Associated With New Onset Erectile Dysfunction: Insights From a National Registry https://www.smoa.jsexmed.org/article/S2050-1161(21)00158-6/fulltext

(22) Sudden sensorineural hearing loss in COVID-19: A case series from the Wrightington, Wigan and Leigh Teaching Hospitals, United Kingdom https://pubmed.ncbi.nlm.nih.gov/34558562/

(23) Incidence of Hearing Loss in COVID-19 Patients: A COVID Hospital-based Study in the Eastern Part of India https://ijcrr.com/uploads/3357_pdf.pdf

(24) COVID-19 and Sudden Sensorineural Hearing Loss: A Systematic Review https://www.frontiersin.org/articles/10.3389/fneur.2022.883749/full

(25) Hearing Loss, Tinnitus, and Dizziness in COVID-19: A Systematic Review and Meta-Analysis https://www.cambridge.org/core/journals/canadian-journal-of-neurological-sciences/article/hearing-loss-tinnitus-and-dizziness-in-covid19-a-systematic-review-and-metaanalysis/0AAEFD3E7D35CCF68415E38BDC493E63

(26) Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection https://www.nature.com/articles/s41590-021-01113-x

(27)   Autoimmunity is a hallmark of post-COVID syndrome https://translational-medicine.biomedcentral.com/articles/10.1186/s12967-022-03328-4

(28) Immuno-proteomic profiling reveals aberrant immune cell regulation in the airways of individuals with ongoing post-COVID-19 respiratory disease https://www.sciencedirect.com/science/article/pii/S1074761322000462

(29)   COVID-19 and Immune Dysregulation, a Summary and Resource https://whn.global/scientific/covid19-immune-dysregulation/

(30) COVID Effects on the Brain, a Summary and Resource https://whn.global/scientific/covid-effects-on-the-brain-a-summary-and-resource/

(31) COVID-19 and Eye A Review of Ophthalmic Manifestations of COVID-19 https://journals.lww.com/ijo/Fulltext/2021/03000/COVID_19_and_Eye__A_Review_of_Ophthalmic.8.aspx

(32) SARS-CoV-2 infects and replicates in photoreceptor and retinal ganglion cells of human retinal organoids https://www.cell.com/stem-cell-reports/fulltext/S2213-6711(22)00104-7?

(33) Common skin signs of COVID-19 in adults: An update https://www.ccjm.org/content/89/3/161

(34) Dermatologic manifestations and complications of COVID-19 https://www.sciencedirect.com/science/article/pii/S0735675720304861?via%3Dihub

(35) COVID-19 – A vascular disease https://www.sciencedirect.com/science/article/pii/S1050173820301286?via%3Dihub

(36) COVID-19: A Serious Vascular Disease with Primary Symptoms of a Respiratory Ailment https://academic.oup.com/jalm/article/6/5/1099/6317833

(37) Is coronavirus a disease of the blood vessels?   https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/coronavirus-and-your-health/is-coronavirus-a-disease-of-the-blood-vessels

(38) COVID-19 infection: an overview on cytokine storm and related interventions https://virologyj.biomedcentral.com/articles/10.1186/s12985-022-01814-1

(39) SARS-CoV-2 infection results in immune responses in the respiratory tract and peripheral blood that suggest mechanisms of disease severity https://www.nature.com/articles/s41467-022-30088-y

(40)Ten scientific reasons in support of airborne transmission of SARS-CoV-2 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00869-2/fulltext

(41) Similarities and Differences between Flu and COVID-19​ https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm

(42) Long Covid is keeping millions out of work – and worsening labor shortage in the US https://www.theguardian.com/commentisfree/2022/sep/15/long-covid-is-keeping-millions-out-of-work-and-worsening-our-labor-shortage

(43) Long COVID Appears to Have Led to a Surge of the Disabled in the Workplace https://libertystreeteconomics.newyorkfed.org/2022/10/long-covid-appears-to-have-led-to-a-surge-of-the-disabled-in-the-workplace/

(44) Hospitals That Ditch Masks Risk Exposure

https://blog.petrieflom.law.harvard.edu/2023/02/20/hospital-liability-covid-infection/

 

Pirates are Progressive

 

 

 

In Brecht & Weill's "Threepenny Opera" the song "Pirate Jenny" expresses a downtrodden woman worker's desire for revenge against her oppressors and for autonomy and adventure for herself.  She imagines a pirate ship giving her the decision to destroy her enemies, and giving her the chance to depart with the pirates. 

 

It's a fantasy, but it has some grounding in truth.  There were, historically, women pirates in what's known as the Golden Age of Piracy--the late seventeenth and especially the early eighteenth century.  Among the most famous were Anne Bonny and Mary Read, whom we know of because they had the bad luck to enter the historical record by getting caught. 

 

The--ahem--employment opportunities available to women in piracy is of a piece with other things we know about pirates in that early eighteenth-century era.  As both scholarly sources and popular culture record,  golden age pirates formed communities far more egalitarian and democratic than the wider society. 

 

Peter Linebaugh and Marcus Rediker note in their book The Many Headed Hydra:  Sailors, Slaves, Commoners, and the Hidden History of the Revolutionary Atlantic, first published in 2000, that

 

"Women were few aboard ships of any kind in the eighteenth century, but they were numerous enough to inspire ballads about cross-dressing female warriors that became popular among the workers of the Atlantic. Bonny and Read, whose exploits were announced on the cover page of A General History of the Pyrates and no doubt in many another yarn of their own day and after, cursed and swore like sailors, carried their weapons like those well trained in the ways of war, and boarded prize vessels as only the most daring and respected members of pirate crews were permitted to do. Operating beyond the reach of the traditional powers of family, state, and capital, and sharing in the rough solidarity of life among maritime outlaws, they added another dimension altogether to the subversive appeal of piracy by seizing the liberties usually reserved for men, at a time when the sphere of social action for women was narrowing."

 

Linebaugh and Rediker's book focuses on the multicultural proletarian resistance to the massive organization and exploitation of human labor that enabled the rise of capitalism, and they highlight the congruence among the plantation, the factory, and the ships both mercantile and military that linked the transatlantic economy. 

 

Writing history "from below,"  they note, they "recover some of the lost history of the multiethnic class that was essential to the rise of capitalism and the modern, global economy. The historic invisibility of many of the book’s subjects owes much to the repression originally visited upon them: the violence of the stake, the chopping block, the gallows, and the shackles of a ship’s dark hold."

 

Ships brought together workers from around the world.  In Europe, "the enclosure of land and the removal of thousands of people from the commons," the common land that had previously been the source of shared resources and survival, meant that people were displaced and "redeployed to the country, town, and sea. Expropriation was the source of the original accumulation of capital, and the force that transformed land and labor into commodities."  Those sailors, often conscripted, press-ganged, or kidnapped into their new roles, suffered brutal, top-down control.  But they also encountered each other, and thus began to develop a common language and a common culture of resistance and rebellion. 

 

As David Graeber notes in his postumously published book Pirate Enlightenment, or the Real Libertalia, which came out this year, these rebellious and globally multicultural environments became "perfect laboratories of democratic experiment."  While Graeber's focus is on pirate communities in Madagascar, he places these in context of the enlightenment ideas and pirate legends of the era, as part of a project of "decolonizing the Enlightenment."  Suggesting that the popularity of "pirate legends" marks them as themselves "a material force in history," he calls them "the most important form of poetic expression produced by the emerging North Atlantic proletariat, whose exploitation laid the ground for the industrial revolution." 

 

Unlike the lawful ships they escaped from or took over, pirate ships were noted for democracy--electing their captains, collectively agreeing on their codes of conduct, offering every sailor a say in major decisions, and providing a system of checks and balances in operation.  As Graeber points out, the phenomenon of "pirate amity" was real:  although they were "constantly armed and frequently drunk" they "virtually never came to blows with one another." 

 

This amicable democratic governance extended to their economies, since both rations and booty were usually divided fairly equally; even if the captain and officers got twice or one-and-a-half times the share of loot that a common sailor got, that difference was far less than in legal military or mercantile ships--or, certainly, in modern corporations.  They also offered workers compensation.  The common image of pirates with eye patches, wooden legs, or hooks for hands reflected some of the physical dangers of sailing, but those injured were generally given a larger share of any prizes. 

 

The popular tales of pirates that resonate most for me today are not those in boys' books or Disney rides, but two televisual series that offer especially egalitarian, anti-imperialist, and queer tales:  Black Sails, which streamed on STARZ from 2014-2017, and Our Flag Means Death, which will be releasing a second season on HBO sometime this year. 

 

As in historical accounts, the casts are multiracial and multigender.  Graeber notes that a pirate ship might include "Englishmen, Swedes, escaped African slaves, Carribean Creoles, Native Americans, and Arabs," and both series reflect this diversity in the crews we see.  These pirate tales also include women, as I began by noting, and they also include queer people. 

 

Evidence sugests that Anne Bonny and Mary Read were lovers, and that sexual relationships between men were common on pirate ships, even sanctioned by the relation of matelotage.   Our Flag Means Death also includes a nonbinary character played by a nonbinary actor. 

 

Both series also offer forms of class critique from below.  Black Sails is more serious, violent, and explicitly anti-imperialist, while Our Flag Means Death is much lighter and funnier, more... gay.

 

These shows do include, between them, most of the romantic cliches of the genre that are omitted from the Under the Banner of King Death: Pirates of the Atlantic, a Graphic Novel, out this year from Marcus Rediker and David Lester with Paul Buhle. That book offers no "hunts for buried treasure, no ghost ships, no wronged aristocrats driven to sea, and no pirates in love with the governor’s beautiful daughter."

 

But all of these texts still speak to "why we need pirates,"  "as long as there are powerful people to be resisted and causes of social justice to be fought for."

Rethinking 'Back to Normal' in the Pandemicine

 

I really want Left organizations to rethink "back to normal" in the pandemicine. 

I can't tell you how demoralizing it is to see announcements of meetings or other events that I might want to go to, but for which I  see no information about Covid precautions.  Is it virtual? or hybrid?  Will people be wearing respirators?  What's the ventilation like in that indoor venue?  Are we living on separate planets? 

Nate Holdren, writing recently in Peste Magazine, has described this feeling as "Broken Sociality":

"Experiences of community are offered but not actually present, in that they're present only via serious risks which are often un- or under-acknowledged." Holdren calls this "social loneliness,"  because it means "reduced time doing things and seeing people compared to pre-pandemic -- because fewer places are doing anything (let alone enough) to mitigate covid exposure"  and it can also mean feeling alone in a crowd because one is the only person wearing a respirator.   

 This "social loneliness," Holdren notes,  "blurs into another facet of broken sociality. . . political loneliness. This is the sense of a gulf in values or in understanding of some very important aspects of the world. Knowing that the [supposed] return to normal means even more dying and life-altering suffering is terrible. Knowing that many people seem not to realize this, that people in officially respected positions seem to find this acceptable, that fellow travelers on the left don’t treat this as a priority, that all feels isolating to a degree I find hard to overstate."

 

As Holdren notes, this affective experience is of course less awful than the  "suffering, inequality, disablement, and death" that the "pseudo-return" to normal is creating. 

But it's not unrelated, and it all bodes ill for our collective future.  

 

I have harped on some of these concerns before, and I still find it demoralizing to see announcements of supposedly progressive meetings or events that show not a bit of concern about the continuing  social murder.  

 

But as Holdren notes, it would be wrong to hold any of this against the powerless folks just trying to make it though.  The problem lies with the ruling class--capitalist, government, and mainstream media--who have been trying to enforce back to normal for years now.  

But despite that sociological construction of the end of the pandemic emergency, the SARS-Cov-2 pandemic has of course not really ended. Covid is still killing hundreds of people each day in the US, and debilitating and disabling even more. 

 

Wastewater levels--one of the only reliable measures of transmission still available now that tests are less available, less accurate, and less reported--have since last summer remained persistently higher than they were any time before the January '22 Omicron wave.  Although vaccines have massively reduced the death toll during the initial, acute phase of illness, their efficacy wanes in a few months, and even at their best they do relatively little to reduce transmission, long covid, or other health impacts.  

 

And the long term damage for survivors can be severe.  The CDC acknowledges that about 20% of those infected get long covid, and other estimates are much higher.  Even among the asymptomatic, each infection increases the risk of heart attack, stroke, brain damage, diabetes, and other bodily damage. The virus seems to increase the risk and progression of cancer.  It impairs the immune system, making people more vulnerable to other illnesses.

 

Moreover, each transmission increases the chances for the virus to mutate again and potentially to become more harmful--it has already become more immune resistant and undermined previously useful treatments like Evusheld and monoclonal antibodies--and there is no indication the virus is getting milder, despite a common myth about how viruses tend to evolve.

 

We can also note that the impact of the pandemic disproportionately harms workers and poor people  and people of color  and  incarcerated people and of course the swelling ranks of people with disabilities.

 

Some of groups have, unsurprisingly, been among the most thoughtful about maintaining precautions.

 

Here in Portland, for instance, The Cascade Festival of African Films offered opportunities for viewing films online--which also came in handy during the late February snowstorms.  

 

Disability justice groups have created helpful guides to planning events with an eye to inclusion as well as to crip survival.   Pandemic research for the people has a primer on mutual aid inthe pandemic. And the Death Panel Podcast has two episodes about organizing and Covid.

 

So, here are some tips on Practicing Inclusion in the Time of COVID from the group Strategies for High Impact.  

When your group organizes a meeting or other event, think about how to make it genuinely inclusive.  Think about how welcoming it might be, or not, to those who can't afford to take time off from work if they get sick, or how welcoming it is to those who are immune-suppressed, or immune-compromised, or already suffering Long Covid, or otherwise debilitated or disabled, or who have family members who are.

 

And if you really want to welcome those folks, then ask yourself and your fellow organizers,  Can we hold our gathering online? If not, how about providing, wearing, and requiring KN95 masks or N95 respirators? (Because yes, respirators do work!) 

 

How about having a hybrid meeting option? How about meeting outdoors or creating more airflow indoors?  

 

If you are using an indoor venue, can you find out what the ventilation is like?  Can the owners or managers of the space tell you how many air changes per hour the HVAC system provides?  Can you test the space to see what the Carbon Dioxide levels are like when it's filled with people?  Can you build DIY air filters to help clear the air?

 

When you annouce your meeting or event, let people know what kinds of precautions are in place.  Show that you've thought about it.  And plan ahead to follow through.

 

What are you willing to do as a group to protect people from COVID exposure? How can you ensure that agreed-upon practices will be followed?

 

So let's do what we can to mitigate the harms of a failed or failing system of public health, to build solidarity, and to keep ourselves, our allies, our accomplices, and our movements as strong and sharp as possible for the long struggle ahead.

See also:

 

Let them eat plague

 

Able-bodied leftists cannot abandon disabled solidarity to move on from covid

 

Why has the left deproritized covid?

The revolution will not be ableist

 

Disability justice organizers dream big and resist a culture of disposability

Social Reproduction and Trans Liberation

 

A speaker at the Conservative Political Action Conference earlier this month called for the eradication of "transgenderism," but said that doesn't mean he's calling for the elimination of transgender people.  If we take him at his word about eradicating the category but not the people, maybe he wants to eliminate cis people.  Transition for all! 

 

Yeah, you know that's not what he meant.  You may have heard that Tennessee legislators recently looked around at the collapsing climate and collapsing banks and exploding trains and raging pandemic and rising hunger and revival of child labor and decided that the important thing to do was to ...ban drag shows? 

You will have noticed the enormous number of anti-LGBTQ bills floated in recent years, and particularly the number directed against Trans people--hundreds of them, and the number of bills seems to grow every year. 

 

 In Oregon the ACLU is tracking seven such bills affecting healthcare and education. 

Clearly, like attacks on abortion access and reproductive freedom, or measures against immigrants, or against African-American Studies (or what Chris Rufo has called Critical Race Theory), these are forms of scapegoating, measures that divide the working class, deflect attention from the dangers posed by the owning class, and help rally a distressed population in the service of a right wing agenda. 

 

Also clearly, they do not spring out of nowhere. Cultural campaigns are funded by think tanks and dark money, but the messages proliferate not only on alt-right websites and right-wing television, but also in mainstream venues like The New York Times, which in February received open letters from the Gay and Lesbian Alliance Against Defamation (GLAAD) and from Times contributors, among others.  Not all of these attacks operate in the same ways, or even perhaps from entirely the same motives, but they all contribute to a cumulative effect of making the world more dangerous for trans people--and for all of us. 

 

Moreover, like attacks on abortion rights, attacks on trans rights and queer sociality "aim to enforce the bourgeois family by any means necessary." As Noah Zazanis noted last year in Spectre magazine, 

 

"much like the anti-abortion movement, the anti-trans movement situates children’s bodily autonomy as a gateway to sexual abuse and sex trafficking, despite research showing that a sense of ownership/agentic control over one’s own body protects against such victimization. While most children who experience sexual abuse are victimized by someone close to the family, the heterosexual family never faces such “groomer” accusations. “Grooming” libel is not actually about sexual abuse, but instead targets trans and queer adults as sources of “social contagion.” Providing support and historical or cultural context for trans/queer youth is suspect precisely because it models possibilities outside of cisgender/heterosexual expectations. As such, these attacks are a core tactic of right-wing organizing." 

 

But why do the bourgeois family and cisgender identity--forms so very natural and innate  that they must be enforced through ideological propaganda and state legislation--why do challenges to these forms generate such panic?

 

In Feminism for the 99 Percent, Cinzia Arruzza, Tithi Bhattacharya, and Nancy Fraser argue that “Gender oppression in capitalist societies is rooted in the subordination of social reproduction to production for profit."  "Social Reproduction" is all the work of "people-making": not only all of the "activity [to] create and sustain life in the biological sense" but also . . . fashioning people with the “right” attitudes, dispositions, and values—abilities, competences, and skills. All told, people-making work supplies some fundamental preconditions—material, social, cultural—for human society in general and for capitalist production in particular. Without it neither life nor labor power could be embodied in human beings." 

 

Under capitalism, this work has been largely separated from the work of profit making, assigned to women, and subordinated to profit-making. "disguised and disavowed." "Because capital avoids paying for this work to the extent that it can, . . . it relegates those who perform social-reproductive labor to a position of subordination—not only to the owners of capital, but also to those more advantaged waged workers who can offload the responsibility for it onto others. Those “others” are largely female." But they are also often people of color, poor, and immigrant workers, who usually also perform this labor, unpaid, for their own families. Social reproduction in capitalism is thus an issue of gender, but also one "shot through at every point by the fault lines of class, race, sexuality, and nation." 

 

The work of people making has historically been enhanced by public social supports; the basic needs for food, housing, healthcare, and education are part of social reproduction. And, you may have noticed, those are increasingly difficult to come by in the US.  Even pre-pandemic figures look bad; according to US government figures, in 2020, 38.3 million US households were food insecure, and on an average night in 2020, 580 thousand U.S. residents were unhoused. 

 

Back in 2006, the Beyond Marriage statement pointed out that  

 

"the Right has mounted a long-term strategic battle to dismantle all public service and benefit programs and civic values that were established beginning in the 1930s, initially as a response to widening poverty and the Great Depression. The push to privatize Social Security and many other human needs benefits, programs, and resources that serve as lifelines for many . . . is at the center of this attack. …All but the most privileged households and families are in jeopardy as a result of a wholesale right-wing assault on funding for human needs, including Medicare, Medicaid, welfare, HIV-AIDS research and treatment, public education, affordable housing, and more. [The] broader conservative agenda of coercive, patriarchal marriage promotion … plays out in … a variety of ways – all of which disproportionately impact poor, immigrant, and people-of-color communities. The purpose is not only to enforce narrow, heterosexist definitions of marriage and coerce conformity, but also to slash to the bone governmental funding for a wide array of family programs, including childcare, healthcare and reproductive services, and nutrition, and transfer responsibility for financial survival to families themselves." 

 

 But we are in a period of realignment and transition, and the picture is complicated by both the differences and the congruence between what at first sight look like forces of sexual reaction and sexual liberalism. One side want to outlaw what they claim are violations of divine or natural law; the other supports legal rights like gay marriage and military participation. As Eric Maroney notes in Tempest, "The ruling class and its ideologues do not agree on how to maintain profitability while also addressing the crisis of care." The authors of Feminism for the 99% likewise point out that "Increasingly financialized, globalized, and de-familialized, capital is no longer implacably opposed to queer and non-cis sex/gender formations. Nor do large corporations still insist on one and only one normative form of family or sex; many of them are now willing to permit significant numbers of their employees to live outside heterosexual families—that is, provided they toe the line, both at the workplace and at the mall." 

 

Thus we have corporations like Amazon, Dow, Shell, Google, and Pfizer signing on to a petition opposing the wave of anti-LGBTQ legislation, in the belief that queer "workers have assimilated into capital and can be conscripted to provide the same social reproductive labor that cis/hetero families do."  

 

So while the "political Left identifies the source of familial precarity as an intentional set of socioeconomic policies, the Right identifies the source as a lapse in values" and, Maroney suggests, the right has some basis, however misguided, for their thinking. 

 

"Not only has the nature and wages of work changed, but that change has also coincided with a corporate identity politics which can be interpreted as undermining the family and traditional sex roles. Neoliberalism is defined as both a set of market policies and a cultural project that disrupts social patterns. Traditional gender roles then become the political right’s antidote to the alienation and individualism of neoliberalism. . . . the anti-gender movement is not a simple backlash to the relative advances achieved by LGBTQ people and cisgender women; it is also bound up in rejection to the neoliberal order wherein “western liberal elites are equated with global economic elites.” 

 

 We might speculate, too, that increasing precarity heightens the need for scapegoats even as the scramble for profit means "sexual dissidence finds a niche as a source of ... advertising images, product lines, lifestyle commodities, and prepackaged pleasures." We might speculate that the New York Times and similar neoliberal forces are willing to go along with some of the anti-trans panic insofar as they interpret it as serving their interests, in the same way that the anger-fueling algorithms of YouTube  or Fox News generate attention, eyeballs, and thus profit.

 

The ruling class is internally divided, but not so much that it offers any way out. The rollback of Roe v Wade pleases misogynists, for instance, but also,"Regulating and surveilling childbearing bodies leads to greater precarity, and precarious bodies are more vulnerable to both productive and reproductive exploitation." Or, again, extensions of criminalization both divide populations and help fuel the for-profit punishment industries. Attacks on public education and on what children are allowed to read or teachers to teach not only move toward making for a less-educated, more prejudiced, potentially more docile public, but also help surveil and de-professionalize the work of teaching, foster union busting, and create further openings for the privatization of schooling and the extraction of profit from it. 

 

In short, there are some complexities to these attacks and their motives and goals, but we need to recognize that "attacks on transgender and gender nonconforming people are part of the ruling-class offensive against social provisioning." As Maroney concludes, "Queer liberation is not just about rolling back the most recent legislative attacks, but also about progressive tax reform, state-funded healthcare, state-funded childcare, and elder care. All these material preconditions are required for the bodily sovereignty of all working people, trans-bodied and cis-bodied people alike." Leftists need to support these goals "in a non-reductive way that acknowledges . . . the unique exploitative conditions that trans people face" and we cannot settle "for a politics of representation that situates trans identities in the context of corporate Diversity, Equity, and Inclusion campaigns" because that "not only fails to meet the material needs of trans people, but also [may provide] further credibility to the [right-wing] claim that trans and queer liberation are the conjuring of a wealthy elite." 

 

"The far-right attacks on transgender people stem from profound social anxiety over the crises posed by neoliberal capitalism, which ruthlessly privatizes care and imperils ordinary people’s lives. Scapegoating transgender and gender nonconforming people for transgressing essentialist definitions of gendered family values is thus part and parcel of the privatization of social reproduction necessary for neoliberal capitalism to sustain itself. Every fight against exploitation and oppression is thus a fight for trans liberation, and ...trans liberation struggles [are] fundamental to . . . anti-capitalist politics."

Health Communism on an Inflamed Planet

Two recent books, Health Communism and Inflamed: Deep Medicine and the Anatomy of Injustice, offer counterarguments to the abandonment of public health, calling for more expansive understandings of human well-being and its interconnection with all of our social and environmental conditions. 

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The Biden Administration's plans to end the pandemic emergency declaration and related programs means not only the end to free vaccines and tests and the chance for Big Pharma to raise vaccine prices exorbitantly. It also means ending telehealth options and depriving some 15 million Americans of access to Medicaid--including nearly seven million who will still be poor enough to qualify but are unlikely to be able to meet the paperwork requirements.  It means ending supplemental food support programs, even though food banks have been hard pressed to meet people's needs even with the additional federal support.

 It continues a process of abandoning the spirit of public health that has been under attack from officials at least since the CDC told us that those who are vaccinated need not wear a mask and that one-way masking will protect individuals. 

To be clear, the end of the emergency declaration does not mean the end of the pandemic, which is likely to become even more damaging, as it continues to spread with even fewer checks, and thus to evolve ever more variants of unpredictable severity. What we can predict is that the effects of this pandemic--and the next ones sure to come--will inflict most damage on those already disadvantaged. 

As is well known, people of color have experienced higher levels of infection and death from Covid-19. Women and trans people have been more likely to experience long covid--the persistent symptoms that can last week, months, or years after the initial infection.  These disparities are not the effects of some inherent weakness or failure in oppressed groups (despite what fascist health supremacists might suggest), but the cumulative impact of suffering that oppression. 

In their 2021 book Inflamed: Deep Medicine and the Anatomy of Injustice, authors Rupa Marya and Raj Patel draw a series of analogies between the body and the planet as they explore the systemic inflammation resulting from capitalism and colonialism. The book explains that when tissues are damaged or threatened, our immune system sends cells and molecular messengers that attack invaders, repair damage, and restore the body to health. Sometimes, “the response doesn’t switch off, and the result is a chronic inflammatory state. When that happens, the body’s healing mechanism is transformed into a smoldering fire that creates ongoing harm.” Leading causes of this chronic inflammation include malnutrition, environmental toxins, and stress. That is, lack of adequate food; proximity to toxins, for instance, because of dangerous workplaces or the siting of toxic dumps near black, brown, indigenous homes; and stress--the result of suffering the effects of structural, institutional, and interpersonal racism, sexism, and other oppressions--lead to chronic inflammation, which contributes to cancer, heart disease, diabetes, colitis, asthma, and other illness. Marya and Patel argue that individuals can be healthy “only when the entire community is also healthy…this is achievable only through social, economic, political, ecological, and cosmological spheres working in an integrated fashion for the benefit of all.” 

As the pandemic has continued, some have suggested that the impact on the labor market and the increasing difficulty of reliably staffing any business with an ever-more debilitated population will eventually cause a shift in public policy toward ensuring a healthy workforce. That argument might have stronger historical basis if we look at the military, since, for instance, some of the nutrition programs in western nations resulted from the discovery of how much of the population was too malnourished from the Great Depression to fight World War II.

But I think a more persuasive account of the current political economy of healthcare can be found in Health Communism, the recent book by Beatrice Adler-Bolton and Arnie Vierkant, co-hosts of the Death Panel podcast. Adler-Bolton and Vierkant argue that capitalism makes a fuzzy and unstable but crucial distinction between two populations: the workers and the surplus, and capitalist healthcare is the system of managing the surplus, the “unwanted, discarded bodies viewed as waste.” We can see this division being made in the way that disability is defined, for instance, when Social Security Disability Insurance uses the simplified metric of how a particular illness or condition impacts an individual’s capacity to work. 

Moreover, those in the “worker” category constantly face the threat of falling into the latter category, as they will, since the surplus includes ex-workers who are no longer able to produce capital, whether because of age or other factors. But while this system treats certain populations as surplus, as waste, it also depends on these populations to exist. The surplus also become a source of extraction and profit, with various industries developing to extract value from them, whether through policing or through care. 

In April 2020 as the pandemic took hold in the US, as hospitals were overwhelmed with covid patients and health workers were hailed as essential and heroic, 1.4 million hospital workers were laid off.  As the New York Times put it at the time, "plunging revenues from canceled nonemergency medical appointments have forced hospitals to furlough or cut the pay of doctors, nurses and other staff" (and I note that "forced" is the language of the Times) tossing many of those workers into the surplus category. Meanwhile, as Eric Reinhart recently noted in a Times opinion piece about the demoralization of medical workers,  "ostensibly nonprofit charity hospitals have illegally saddled poor patients with debt for receiving care to which they were entitled without cost and have turned large profits by exploiting tax incentives meant to promote care for poor communities. Hospitals are deliberately understaffing themselves and undercutting patient care while sitting on billions of dollars in cash reserves." 

Adler-Bolton and Vierkant describe this process as "extractive abandonment," a concept they develop by drawing on Ruth Wilson Gilmore's work on imprisonment and the notion of "organized state abandonment" and Marta Russell's work on Capitalism and Disability. For Wilson Gilmore, this abandonment appears as a withdrawal of the state but is actually a strategy of racial capitalist state formation to exploit vulnerable communities, and it signals the process of governing populations through callous yet purposeful neglect, framing many humans and other lifeforms as surplus to the contemporary political economic order. 

Health Communism also draws on “Marta Russell’s money model of disability" which "theorizes that while the disabled—the surplus population—are widely regarded as a “drain” on the economy, in truth over time capital and the state have constructed systems to reclaim this lost population as a source of financial production. Russell situates these systems as manifesting through charity fundraising, the prioritization of care aimed toward the “repair” of disabled people to become workers, and through policies that grow the private sector through for-profit private nursing home care paid for by publicly funded, means-tested state health care programs.” 

Ultimately, the authors of Health Communism call for left projects to center the "waste," because “deviants, the surplus, and the sick form the central class that can bring about the fall of capital.” They argue that “It is not necessarily the case that we are all sick. But none of us is well." "Health" is "a biological fascist fantasy" "a subjective dream of an unattenuated 'wellness,' a body state [they] deny any being has ever known." "Capital has emphasized and corrupted the delineations between surplus classes for its convenience; it is immeasurably threatening to capital to see a group of those it has deemed to be waste come together in solidarity. ” "The truth of the distinction that capitalist states draw in their demarcations of worker/surplus is that in the eyes of capital, we are all surplus."